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Biomedical subjects

M Westhofen

Publications and source records attributed to M Westhofen.

At least 19 recordsLinked to original sources
PubMed2005

[Infectious mononucleosis].

The primary infection with Epstein-Barr virus in an immunocompetent individual leads to infectious mononucleosis with symptoms of diphtheroid angina, lymph node swelling in the neck and hepatosplenomegaly. The most common age of infection lies between 15 and 25 years. The illness can affect a number of organs simultaneously and thus requires interdisciplinary diagnostics. For differential diagnosis, a differential blood analysis and a EBV quick test are required. The presence of IgM antibodies demonstrates the presence of the infection. Ultrasound of the abdomen can be made to determine the involvement of additional organs. In most cases, recovery occurs without complications. Acute cases can usually be handled successfully with medication. If symptomatic treatment fails, pharyngeal airway obstruction is possible and a tonsillectomy may be necessary. Otherwise, surgical treatment is obsolete. Generally, the prognosis is good. Severe courses and complications are rare.

Humans↗
PubMed2004

[Function tests for the Eustachian tube. Current knowledge].

The Eustachian tube regulates the homeostasis of the middle ear. Problems with its function are predominantly found in childhood. As a consequence, otitis and hearing impairment occur. The most important muscle is the tensor tympani muscle. The complexity of the functional anatomy and physiology are reasons why no function test alone is capable of fulfilling all diagnostic needs. The predictive value of the various Eustachian tube function tests for the outcome of a tympanoplasty is not yet clear. An overview of clinically and scientifically relevant tests for the Eustachian tube function is provided.

Eustachian Tube↗
PubMed2004

[Cochlear reimplantation - experiences and results].

BACKGROUND: There have been remarkable developments in Cochlear Implants in the past years. Technical improvements lead to more reliable and durable devices. In cases of traumatic and atraumatic device failure a reimplantation of the Cochlear Implant is necessary. METHODS: In a retrospective study we examined 15 patients with 17 Cochlear reimplantation procedures after a traumatic or atraumatic device failure between 1996 and 2002. The reasons leading to the revision, the intraoperative findings, the perioperative complications and the postoperative audiological results as well as the personal evaluation of the revision procedure were analyzed. RESULTS: In our study there were 11 children and 4 adults. In 10 cases a traumatic and in 7 cases an atraumatic device failure lead to the reimplantation. In 13 of the 15 patients the revision surgery took place within 1 month after the date of device failure. The electrode array could be reinserted safely without any perioperative complications. The postoperative results showed a continuous development of speech perception in all patients. The personal evaluation of the reimplantation procedure was positive in all cases. CONCLUSIONS: Cochlear reimplantation in cases of traumatic or atraumatic device failure is a safe procedure without any serious perioperative complications. The timely reimplantation leads to a continuous development of speech perception.

Age Factors↗
PubMed2004

[Conservative treatment in mild obstructive sleep apnea: comparison of theophylline and nasal continous positive airway pressure ventilation].

BACKGROUND: Comparison of theophylline and nasal continous positive airway pressure-ventilation (nCPAP) in patients non eligible for surgical treatment with obstructive sleep apnea. PATIENTS AND MATERIALS: In a prospective non-randomized study 60 patients with mild obstructive sleep apnea were investigated. All individuals were not eligible for surgery under general anaesthesia or refused surgical treatment. The efficacy of a daily single dose oral theophylline (5 - 7 mg/kg body weight, n = 30) and nCPAP ventilation (n = 30) was evaluated by apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS). Statistical data analysis was performed using the Wilcoxon-Test. RESULTS: In the theophylline group 4/26 patients (15 %) showed a mean AHI reduction of 42 %. The ESS-Score improved from 10.0 to 8.0. Therapy compliance was 86 %. The non-responder (22/26 patients, 85 %) group showed a mean AHI increase of 11 % (from 24.6 to 27.3). This difference was not of statistical significance (p < or = 0.878). In the CPAP group the AHI decreased from 23.3 to 2.9 (p < or = 0,0001). Mean ventilation pressure was 6.4 mbar. The ESS-Score improved from 10 to 8. Compliance was 50 %. Six of thirty patients (20 %) did not use the CPAP device regularly. During the first four weeks another nine of thirty (30.7 %) patients turned back the device. Main reasons were discomfort (61 %), noise (38 %), rhinitis, conjunctivitis and discomfort of the partner (10 %). CONCLUSIONS: None of the treatments investigated can be considered as a substantial alternative for the majority of patients non eligible for surgery. Theophylline has a high compliance but little therapeutic effect. CPAP-ventilation is more effective but has a compliance problem in the patients investigated. Both modalities may have benefit but have to be individually indicated. A multimodal approach may ease the problem.

Administration, Oral↗
PubMed2003

Potassium currents in vestibular type II hair cells activated by hydrostatic pressure.

An elevated hydrostatic pressure in the endolymphatic space of the inner ear is discussed as pathophysiological factor in hydrops-related diseases of the inner ear. An increase in pressure by fractions of 1 cm H(2)O is sufficient to induce vertigo-like symptoms in animal models. To establish a link between hydrostatic pressure and the function of vestibular hair cells, we studied potassium currents in isolated vestibular type II hair cells from guinea-pig utricles when the hydrostatic pressure was increased by raising the height of the bath from 0.2-0.5, 0.7 or 1.0 cm. Elevated pressure enhanced K(+) currents significantly; a rise in pressure from 0.2-0.5 cm H(2)O increased the total K(+) current at +40 mV by 22+/-14% (+/-S.D.). The pressure-sensitive current I(K,p) was non-inactivating during depolarizing pulses. It was maintained when the pressure was kept elevated for several minutes and receded promptly after return to a pressure of 0.2 cm H(2)O. Voltage-gated Ca(2+) currents, in contrast, were not altered by hydrostatic pressure. A pharmacological characterization of I(K,p) revealed that tetraetylammonium (100 mM) abolished all outward currents including I(K,p). I(K,p) was partly and reversibly inhibited by 4-aminopyridine. Dihydrostreptomycin, a blocker of the transduction channel, left I(K,p) unaffected. Charybdotoxin (100 nM), a blocker of Ca(2+)-dependent K(+) channels, completely yet reversibly abolished I(K,p). We conclude that small elevations in hydrostatic pressure evoke a charybdotoxin-sensitive, probably Ca(2+)-dependent K(+) current in vestibular hair cells. This is likely to alter their frequency response and may be a relevant mechanism how hydrostatic pressure disturbs transduction.

Animals↗
PubMed2003

[Testing of the macula induced vestibuloocular reflex--possibilities and problems in the clinical routine].

INTRODUCTION: During the last years, an increasing number of papers is presented dealing with diseases and diagnostic procedures of the macula function. On the other hand, there are just a few distinct test setups for this purpose. In clinical routine, this kind of test system has to be efficient and effective to diagnostic and therapeutic findings. METHODS: The presented test setup includes examination of the semicircular canals by means of harmonic acceleration pendular rotation test and the bilateral, bithermal test as well as otolith function tests i. e. off vertical axis rotation (OVAR) and eccentric rotation. From March 1999 to May 2000 522 patients with dizziness were examined. RESULTS: Otolith tests results could be assessed in a range between 87 % to 95 % of the cases. The quality failure rate was significantly higher than in findings of semicircular canals examination procedures. The major caused technical problem were artifacts. Looking for the diagnostic relevance of the method, 37 % of the patients. Suffering from dizziness and who have normal findings in cupula VOR testing procedures revealed isolated macular dysfunctions. DISCUSSION: The relevance for diagnostic is demonstrated. Otolith function tests can be applied in clinical routine and give relevant information for diagnosis and treatment. Macula test procedures are still sophisticated. Technical development of VOG-recording is necessary for their general application in otology.

Acoustic Maculae↗
PubMed2003

[Electro-mechanic steering device for head-lamp mounted miniature video cameras].

BACKGROUND: Endoscopic or microscopic video recordings set a widely established standard for medico-legal documentation of operative procedures. In addition, they are an essential part of undergraduate as well as postgraduate medical education. Macroscopic operations in the head and neck can be recorded by miniaturised video cameras attached to the surgeon's head lamp. METHODS: The authors present an electro-mechanic steering device which has been designed to overcome the parallax error created with a head-mounted video camera, especially as the distance of the camera to the operative field varies. RESULTS: The device can be operated by the theatre staff, while the sterility of the operative field is maintained and the surgeon's physical working range remains unrestricted. As the video image is reliably centred to the operative field throughout the procedure, a better orientation and understanding for spectators who are unfamiliar with the surgical steps is obtained. CONCLUSIONS: While other adverse factors to macroscopic head-mounted video recordings, such as involuntary head movements of the surgeon, remain unchanged, the device adds to a higher quality of video documentation as it relieves the surgeon from adjusting the image field to the regions of interest. Additional benefit could be derived from an auto-focus feature or from image stabilising devices.

Endoscopy↗
PubMed2003

[Sonografic evaluation of oxygenation in head and neck cancer].

BACKGROUND: Tumor oxygenation is an important aspect of radiosensitivity. The authors describe a new method for a non-invasive assessment of tumor oxygenation in head and neck cancer. PATIENTS AND METHODS: A group of 20 patients with neck metastases of squamous cell cancer of the head and neck region was surveyed. At first a pO (2)-polarography was performed in the metastatic cervical nodes to investigate the tissue oxygenation. In a second step, the vascularisation of these nodes was visualised by color duplex sonography. In order to evaluate the extent of vascularisation in these nodes, the density of color pixels was quantified by a custom-made software program. The color pixel density and the pO (2) values were correlated and the statistic significance was calculated by Pearson's test. RESULTS: The mean vascularisation as evaluated by the means of color duplex sonography was 7.78 % [95 % CI 6.04 - 9.51]. The interindividual pO (2) values in the stroma of metastatic lymph nodes ranged between 9.0 and 27.4 mmHg (16.6 [95 % CI 14.06 - 19.13]). The mean values of pO (2)-fractions < 2.5/< 5.0/10 mm Hg were 32.25 %, 44.25 % and 53.29 % respectively. The median value of the pO (2)-fraction was 10.49 % [95 % CI 7.13 - 13.85]. The vascularisation as evaluated by color pixel density showed a statistically significant correlation with the pO (2)-fractions < 5.0 and < 10 mmHg (p < 0.045 and < 0.0001) and with the mean (p < 0.002) and median values of tissue pO (2) values (p < 0.0001) in polarography. CONCLUSION: The results in a limited number of patients suggest, that the proposed sonographic method allows a reliable non-invasive evaluation of tissue oxygenation in cervical metastases of squamous cell head and neck cancers.

Adult↗
PubMed2002

[Vestibular diagnostics in childhood - methods and assessment].

BACKGROUND: Children with vertigo are thought to be difficult to examine. Vestibular test batteries are used less frequently for children than in adult patients. METHODS: Within the context of a retrospective study 136 patients in age between 0 and 15 years, who were examined by Frenzel's glasses, ENG and VOG between 1996 and 1999 were evaluated. Caloric test and frequency selective rotation chair tests were performed. RESULTS: Workability of VOG examination (91 %) was higher than Frenzel glasses (86 %) and ENG (78 %). Videooculography is the method of choice in childhood. Comparing diagnosis after vestibular testing and discharge diagnosis a sensitivity of 68 %, a specificity of 88 %, an accuracy of aim of 79 % and a positive predictive value of 92,9 % was calculated. CONCLUSION: Thus restriction of vestibular functional diagnostics in childhood is not justified.

Adolescent↗
PubMed2002

[Clinical experience with power-regulated contact laser surgery for the paranasal sinuses and the anterior skull base].

BACKGROUND: While laser surgical methods in Otorhinolaryngology have become widely established, their use in revision surgery for chronic-polypous sinusitis has been regarded as hazardous due to the vicinity of the anterior skull base and the orbit. However, new experience with laser-tissue interaction in contact irradiation together with effective power feedback control mechanisms require a re-evaluation of laser revision surgery in this field. PATIENTS AND METHODS: After 742 primary, endonasal-microscopic sinus surgery procedures, 86 patients had 128 Nd:YAG-laser sessions performed within an interval of 1 - 24 months after primary surgery for recurrent polyposis, which had been irresponsive to medication. The maximum power delivered was 10 to 20 W. RESULTS: Recurrent polyposis appeared mostly in the maxillo-ethmoid angle, followed by the maxillary sinus roof and the maxillary sinus bottom. In 63 of 86 patients, no further polyposis was seen after laser surgery. If more than one laser session had to be performed, recurrent polyposis appeared in a different region in most cases. Those areas lasered first showed a reduced tendency to recurrence. There was moderate bleeding during laser surgery in 6 cases with reduced visibility, but no other serious complications were recorded. CONCLUSIONS: Laser surgery for chronic-polypous sinusitis is an alternative to conventional revision surgery, if medical treatment fails and recurrent polyposis is confined to certain regions. Feedback-controlled contact laser power delivery adds further therapeutic safety when applied next to the anterior skull base and the orbit.

Adolescent↗
PubMed2002

[Long-term results of suture-free cutanous wound closure in head and neck incisions with octylcyanoacrylate topival skin adhesive].

BACKGROUND: Cyanoacrylate monomers have been developed for use as skin adhesives. So far, little is known about long-term results concerning functional and aesthetic results of wound closure with octylcyanoacrylate in head and neck region. METHODS: In a prospective, non-randomized study we examined in 59 patients who had undergone surgery in the face and the neck in between 04/99 and 05/00 at the ENT-Department, University of Aachen, Germany. The aesthetic and functional outcome of a cutanous wound closure by use of octylcyanoacrylate was evaluated. Patients were seen preoperatively, postoperatively and in a long-term follow-up (average 7.2 months) for wound control, photographs, and evaluation with a standardized questionnary. RESULTS: In 40 cases a complete follow-up was possible. There were 33 patients (82.5 %) satisfied with the aesthetic and the functional results of wound closure. In four patients (10 %) early complications developed but did not have an impact on the cosmetic result. Three patients showed alterations as hypertrophic scar or persisting redness of the scar in the long-term follow-up. CONCLUSION: Octylcyanoacrylate tissue adhesive was found to be an effective method of skin closure in clean head and neck incisions. It is a fast and simple method of wound closure, providing good cosmetic results with a low infection rate.

Adolescent↗
PubMed2002

[Relevance of colour-duplex echography for detection and therapy of recurrences in the follow-up of head and neck cancer].

BACKGROUND: Head and neck malignancies have a high rate of recurrences. Since the prognosis is often limited an early detection and therapy onset is essential for survival. This study surveys the relevance of regular colour-duplex echography examinations in the follow-up for detection and therapy of recurrent head and neck carcinomas. PATIENTS AND METHODS: In a prospective non-randomized study 43 patients were surveyed over a mean observation period of 28 (8-44) months. In addition to clinical and colour-duplex echography (CDS) examinations, computed tomography (CT) and positron-emission-tomography using 18fluorodeoxyglucose (PET) were performed. RESULTS: A recurrence was detected in 17/43 (39.5 %) patients. The median survival was 42 months. CDS was the most reliable procedure for the diagnosis of regional recurrences with an accuracy of 94.2 %. Sensitivity and specificity of CDS for the diagnosis of all recurrences was found to be 80 % and 78,6 % respectively. CT yielded identical results. In PET sensitivity was 82.4 % and specificity was found to be 88.4 %. In clinical examinations including panendoscopy sensitivity was 64.7 % only. In 7/17 recurrences a therapy was performed with curative intention. In 4 cases an early diagnosis by CDS contributed to a successful therapy. CONCLUSION: CDS is the imaging procedure of choice for the routine follow-up of head and neck cancer patients. In order to perform a comprehensive assessment of the head and neck region, for re-staging and to exclude second primary tumours additional (pan)endoscopy is necessary. CDS supports due to a high resolution and reliability an early therapy onset and a minimal invasive therapy. Thus, this procedure can significantly contribute to the successful treatment of recurrences in head and neck cancer.

Adenocarcinoma↗
PubMed2001

[Low-grade malignant peripheral nerve sheath tumor of the neck soft tissues].

BACKGROUND: Malignant Peripheral Nerve Sheath Tumours (MPNST) either grow sporadically, after radiation or chemotherapy respectively. In many cases they are associated with Neurofibromatosis I. Because of the multiform histologic picture they are often difficult to differentiate from other soft tissue tumours. PATIENT: We present the case of a sporadic MPNST which developed from the vagus nerve of a 39-year-old patient following radiation of the neck 7 years before. After complete excision there has been no recurrence up to now. RESULTS AND CONCLUSIONS: Sporadic MPNST of the head and neck are comparatively rare. With regard to the strong association with Neurofibromatosis I and the difficult differential diagnosis to other soft tissue tumours the emphasis should be put on excluding further manifestations of Neurofibromatosis I and of secondary tumours.

Adult↗
PubMed2001

[Magnetic resonance tomography imaging of the inner ear of patients with sensorineural hearing loss or vertigo].

BACKGROUND: Progress in surgical techniques in the temporal bone has lead to the demand of exact delineation of this complex anatomical region for preoperative planning. The aim of this study was to assess the potential of a three-dimensional T2 weighted turbo-spin-echo-sequence to depict anatomical details and pathological changes of the inner ear. METHODS: Twenty-five patients presenting with sensori-neural hearing loss and/or vertigo were included in this study. A T2 weighted turbo-spin-echo-sequence was carried out on a 1.5 T imager, employing a surface coil with a diameter of 8 cm. The scan parameters were set as follows: TR 2000, TE 500, scan matrix 128 x 128, field of view 90 mm, slice thickness 0.66 mm, NSA 4. In addition, 3D maximum-intensity-projections (MIP) were created, using these data as source images. RESULTS: Image quality was excellent in all 25 cases. The 2.5 cochlear windings, modiolus, vestibule with saccule and utricle all three semicircular canals, crus commune and the facial nerve and vestibulocochlear nerve in the inner auditory canal were clearly delineated in all patients. The cochlear aqueduct was seen in 32% (8 cases), while the vestibular aqueduct was delineated in 16% (4 cases) in this series. In MIP, the entire labyrinth was shown in a single view. In 22 patients regular morphology was found, while in three cases pathological changes were detected (an enlarged vestibular aqueduct and saccus in one patient, partial fibrous obliteration of the labyrinth in two patients). CONCLUSIONS: The introduced TSE sequence can be used to delineate the anatomy of the inner ear as well as pathological changes. The technique appears to be useful for preoperative planning.

Adolescent↗
PubMed2001

[How I do it - total maxillectomy via midfacial degloving].

Midfacial degloving for total maxillectomy in the case of a 67 year old male patient with a maxillary sinus adamantinoma of solid and multicystic plexiform differentiation is presented. This is the first report about surgical treatment of an adamantinoma via midfacial degloving. The importance of preoperative staging by means of computed tomography to exclude cheek infiltration and to plan the extension of maxillary resection is pointed out. The prognosis of the adamantinoma and its histopathological classification is discussed. The postoperative obturation of the resection defect and nasal cavity towards the oral cavity must be prepared preoperatively by the interdisciplinary care of dentistry and ENT surgery. Complete functional restoration of speech, swallowing and esthetic appearance can be achieved. Midfacial degloving for complete maxillectomy is rarely cited. Nevertheless it can be recommended for surgical treatment of maxillary tumours without spread in the cheek muscles and upper lip, even those which need total maxillectomy.

Aged↗
PubMed2000

Diagnosis and staging of head and neck cancer: a comparison of modern imaging modalities (positron emission tomography, computed tomography, color-coded duplex sonography) with panendoscopic and histopathologic findings.

OBJECTIVE: To compare the clinical value of positron emission tomography (PET) using fludeoxyglucose F 18, computed tomography (CT), color-coded duplex sonography (CCDS), and panendoscopy in the detection and staging of head and neck cancer. DESIGN: Prospective nonrandomized controlled study. SETTING: Medical school. PATIENTS: Convenience sample of 50 patients with suspected primary or recurrent head and neck cancer. INTERVENTION: Biopsy, tumor surgery. MAIN OUTCOME MEASURES: Information of diagnostic procedures compared with histopathologic features. RESULTS: Both PET and panendoscopy had a sensitivity of 95% and 100% for detection of primary tumor or recurrent carcinomas, respectively. Specificity for PET and panendoscopy was 92% and 85% in primary tumors and 100% and 80% in recurrent carcinoma, respectively. Sensitivity of CCDS and CT was 74% and 68% in primary tumors and 67% and 63% in recurrent carcinomas, respectively. Specificity was 75% and 69% in primary tumors and 100% and 80% in recurrent neoplasms. When assessing neck nodes, all imaging procedures exhibited identical sensitivity (84%). Specificity was 90%, 96%, and 88% in PET, CT, and CCDS, respectively. In recurrent lymph node metastases, sensitivity was 100%, 67%, and 67% and specificity was 87%, 91%, and 87% for PET, CT, and CCDS, respectively. CONCLUSIONS: Positron emission tomography was the most reliable imaging procedure in the detection of primary tumor and recurrent carcinomas localized in the head and neck region. Owing to its limited anatomical depiction, it cannot as yet replace other diagnostic procedures in preoperative planning but does contribute valuable complementary diagnostic information. Computed tomograpy may have difficulties in identifying recurrent carcinomas. For routine diagnosis of nodal spread in the neck, CCDS is recommended. Panendoscopy is a valuable diagnostic procedure that can provide key information in cases of superficial mucosal tumor involvement. Arch Otolaryngol Head Neck Surg. 2000;126:1457-1461

Biopsy↗
PubMed2000

Color-coded duplex sonography of the cervical lymph nodes: improved differential diagnostic assessment after administration of the signal enhancer SH U 508A (Levovist).

The vascularity of cervical lymph nodes can be documented by means of color-coded duplex sonography and malignant and benign lymph nodes distinguished on the basis of typical patterns of vascularity. However, not all intranodal vessels can be visualized by color-coded duplex sonography, and minute vessels are detectable only after the administration of a signal enhancer. This also makes it possible to assess the morphology of cervical lymph nodes that are inaccessible on plain sonography. In the present study we examined acute and chronic inflammatory and metastatic lymph nodes as well as malignant lymphomas to determine the extent to which a specific pattern of vascularity can be detected with color-coded duplex sonography after the injection of Levovist as a signal enhancer. In addition, digital image processing was used to quantify the vascularity detected in relation to the cross-sectional area of the lymph nodes as seen at sonography and to determine whether there are any differences in lymph node types as regards an increase in the detection of vascularity. After injection of the marker a typical pattern of vascularity could be assigned to all lymph nodes examined and differences shown in quantifying vascularity: This increase was greatest in the acutely inflamed lymph nodes (36.0 +/- 5.0%) and smallest in lymph nodes with chronic inflammation (2.3 +/- 1.3%). These findings show that cervical lymph nodes of varying origin differ by virtue of their pattern of vascularity, with increased vascularity detectable after administration of a signal enhancer.

Carcinoma, Squamous Cell↗